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MassHealth

All-Provider Bulletin 262

November 2016

TO: All Providers Participating in MassHealth

FROM: Daniel Tsai, Assistant Secretary for MassHealth

RE: Accountable Care Organization (ACO) Pilot

Background

Starting December 1, 2016, MassHealth will initiate a one-year ACO Pilot program. The program will be comprised of primary care provider-based Pilot ACOs. These ACOs will coordinate care and be accountable for the total cost of care for their attributed members within MassHealth’s Primary Care Clinician Plan (PCC) Plan.

The experience of these Pilot ACOs will enable MassHealth to

• Evaluate and monitor how effectively Pilot ACOs coordinate and integrate the care of their attributed members;

• Learn how Pilot ACO models impact the health and well-being of MassHealth members;

• Determine how MassHealth providers are affected;

• Study the impact on total cost of attributed member’s care; and

• Analyze how ACOs impact MassHealth operations.

With this information, MassHealth will be better prepared for the full ACO implementation anticipated in December 2017. Please visit hhs/masshealth-innovations for details and updates regarding MassHealth’s ACO program and other MassHealth innovation initiatives. To view the recently issued ACO Request for Responses (RFRs), please visit .

Selected Pilot ACOs

As a result of a competitive procurement process, MassHealth has contracted with the following six organizations to participate in the ACO Pilot program starting December 1, 2016 (please refer to the end of the bulletin for a list of participating providers within each ACO):

• Boston Accountable Care Organization

• Children’s Hospital Integrated Care Organization

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MassHealth

All-Provider Bulletin 262

November 2016

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Selected Pilot ACOs (cont.)

• Community Care Cooperative

• Partners Care Connect

• Steward Medicaid Care Network Inc.

• UMass Memorial Healthcare Inc.

Primary Care Provider Participation and Billing

Primary care providers (PCPs) who participate in the Pilot ACOs must be Primary Care Clinicians (PCCs) in the MassHealth PCC Plan. Each Pilot ACO has identified its PCPs to MassHealth. A list of participating PCC entities for each ACO is included at the end of this bulletin.

Pilot ACOs will not be responsible for directly paying for covered services. PCCs that participate in Pilot ACOs will continue to bill MassHealth and be paid fee-for-service, as they are currently in the PCC Plan.

At the end of the ACO Pilot, MassHealth will conduct a retrospective reconciliation to compare total actual costs of care for each Pilot ACO’s panel of attributed members against total expected costs for each ACO. The Pilot ACOs will share in the savings or losses with MassHealth.

Non-Primary Care Providers Behavioral Health Services and ACO Referral Circles

Pilot ACOs will not be responsible for contracting with a provider network. Members attributed to Pilot ACOs will continue to have access to the full MassHealth provider network of specialists, as they currently do through the PCC Plan. Members attributed to a Pilot ACO will continue to be enrolled in the Massachusetts Behavioral Health Partnership (MBHP) and receive behavioral health services through that network.

Pilot ACOs may identify a list of additional providers of various provider types, with which the ACO has a special relationship. These providers can be included in what is referred to as the ACO’s “referral circle.” The PCC Plan will not require referrals for services provided to ACO-attributed members by providers within the referral circle of the member’s ACO. Referral circles are an optional component of the ACO Pilot model. Pilot ACOs may or may not choose to establish referral circles.

Unless part of the ACO’s referral circle, specialists must continue to comply with the PCC Plan’s referral requirements for services rendered to PCC Plan enrollees. For more information regarding the PCC Plan’s referral requirements, please refer to 130 CMR 450.118: Primary Care Clinician (PCC) Plan.

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MassHealth

All-Provider Bulletin 262

November 2016

Page 3

Member Attribution and Notification

PCC Plan members whose PCC is participating with a Pilot ACO will be attributed to that Pilot ACO. MassHealth will notify PCC Plan members whose PCC is participating in a Pilot ACO. Members will be notified of their ACO attribution prior to December 1, 2016. Members who do not want to participate in the Pilot ACO may choose another PCC that is not participating in a Pilot ACO at any time.

Members should ensure that the PCC they are currently assigned to is the PCC they see for primary care services. If a member receives most primary care services from someone other than their assigned PCC, they should contact MassHealth to change PCCs.

Members can change their PCC by contacting the MassHealth Customer Service Center at 1-800-841-2900 or visiting masshealth (click the “MassHealth Members and Applicants” button on the left and then click the “Enroll in a Health Plan” link).

Additional Information

Additional information on MassHealth’s planned restructuring and payment reforms may be found on the MassHealth Innovations website at hhs/masshealth-innovations.

List of Attributed PCC Entities by ACO

The following PCCs have been identified as participating with the Pilot ACOs. This list is subject to change during the term of the Pilot. Providers should contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@ with questions.

Boston Accountable Care Organization

Participating Primary Care Clinician sites include:

Boston Health Care for the Homeless Program/McInnis Health Group

Boston University Affiliated Physicians

Boston University Family Medicine

Child Health Foundation of Boston

Codman Square Health Center

DotHouse Health

Evans Medical Foundation

Greater New Bedford Community Health Center

Greater Roslindale Medical and Dental Center

HealthFirst Family Care Center

Mattapan Community Health Center

Riverbend Medical Group

Signature Medical Group

South Boston Community Health Center

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MassHealth

All-Provider Bulletin 262

November 2016

Page 4

Boston Accountable Care Organization (cont.)

South End Community Health Center

Stanley Street Treatment and Resources - SSTAR Family Healthcare Center

Upham's Corner Health Center

Children’s Hospital Integrated Care Organization

Participating Primary Care Clinician sites include:

Adolescent Young Adult Med at Boston Children’s Hospital

Boston Children's Hospital

Briarpatch Pediatrics

Bridgewater Pediatrics LLC

Greater Lowell Pediatrics

Horizon Pediatrics, Inc.

Martha Eliot Health Center

Plymouth Pediatric Associates LLC

Wareham Pediatric Association

Community Care Cooperative

Participating Primary Care Clinician sites include:

Brockton Neighborhood Health Center

Community Health Center of Cape Cod

The Dimock Center

East Boston Neighborhood Health Center

Edward M. Kennedy Community Health Center

Family Health Center of Worcester

Family Health Center of Worcester (Webster Square)

Gloucester Family Health Center

Holyoke Health Center

Holyoke Health Center (Chicopee Health Center)

Lynn Community Health Center

Market Square Family Health Services (Lynn Community Health Center)

Market Square Family Health Services at Western Ave (Lynn Community Health Center)

North Shore Community Health Center

Peabody Family Health Center

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MassHealth

All-Provider Bulletin 262

November 2016

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List of Attributed PCC Entities by ACO (cont.)

Partners Care Connect

Participating Primary Care Clinician sites include:

Brigham and Women's Hospital

Brigham and Women’s Physicians Organization

Brookside Community Health Center

Southern Jamaica Plain Health Center

Massachusetts General Hospital

Massachusetts General Physicians Organization

MGH Back Bay

MGH Charlestown Healthcare Center

MGH Revere Health Center

MGH Chelsea Healthcare Center

MGH Everett

MGH Revere Broadway Ave

Newton-Wellesley Ambulatory Services

North Shore Physicians Group

Steward Medicaid Care Network, Inc.

Participating Primary Care Clinician sites include:

Individuals

Andrade, Jorge M., MD

Attar, Laila, MD

Bhatti, Nasir A., MD

Bonnet, Jean S. F., MD

Burns, Paul, MD

Chambers, Natalie MD

Chao, Hanpu, MD

Chapman, Bertrand, MD

Dalton, John W., MD

Dias-Hoff, Lucia, MD

Galizio, Stephen J., MD

Kney, Bradford, MD

Lee, Uhun R., MD

Lee, Walter, MD

Oberti, Frank, DO

O'Connor, James W., MD

Ohri, Goverdhan L., MD

Ohri, Neeta, MD

Ostrov, Julia I., MD

Riad, Mamdouh M., MD

Ruby, Eric J., MD

Santos, Roman N., MD

Schwartz, Melvin J., MD

Sharma, Deepak K., MD

Shih, Shiao-Ang, MD

Steele, James P. Douglas, MD

Tello, Jorge E., MD

Thacker, Neelam M, MD

Tufts, Henry, MD

VandenHeuvel, Cathy L., MD

Vera, Juan C., MD

Welter, Ryan, MD

Zuser, Lydia, MD

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All-Provider Bulletin 262

November 2016

Page 6

Steward Medicaid Care Network, Inc. (cont.)

Organizations

Alexeyenko Medical Associates

Bass River Pediatric Associates

Bolton Primary Care

Bramblebush Pediatrics

Cape Cod Pediatrics LLP

Children's Healthcare, Inc.

Doctors James and Kelly Hoye, Partners in Family Care

Eaton Medical Associates, PLLC

Emerald Physician Services, Inc.

Family Medical Associates PC

Geiger-Gibson Community Health Center

Harbor Community Health Center - Hyannis

Harbor Community Health Center - Plymouth

Harvard Street Neighborhood Health Center

Haverhill Family Practice, LLC

Hawthorn Medical Associates

Highland Pediatrics PC

Internal Medicine Preventive Care

Lawrence Family Doctors

Manet Community Health Center at Hough's Neck

Manet Community Health Center at Hull

Manet Community Health Center at North Quincy

Manet Community Health Center at Snug Harbor

Manet Community Health Center at Taunton

Mill River Pediatrics

Nauset Family Practice

Needham Family Practice Associates, PC

Nepsonet Health Center

New England Allergy, Asthma, Immunology & Primary Care, PC

Pediatric Associates of Fall River, Inc.

Physicians of Cape Cod Hospital

Physicians of Falmouth Hospital

Pleasant Valley Internists

Prima CARE, PC

Prime Medical Associates, LLC

Pulmonary Internists and Consultants

Raynham Taunton Pediatrics

Resil Medical Associates

SMG Branch Internal Medicine

SMG Bridgewater Internal Medicine

SMG Brighton Primary Care

SMG Brockton Cardiology

SMG Brockton Family Medicine

SMG Brockton Internal Medicine

SMG Brookline Primary Care

SMG Carney Hyde Park

SMG Carney Primary Care

SMG Chestnut Green Family Medicine

SMG Compass Medical

SMG Compass Medical, Abington

SMG Compass Medical, Braintree

SMG Compass Medical, East Bridgewater

SMG Compass Medical, Middleboro

SMG Compass Medical, South Easton

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MassHealth

All-Provider Bulletin 262

November 2016

Page 7

Steward Medicaid Care Network, Inc. (cont.)

Organizations (cont.)

SMG Compass Medical, Taunton

SMG Dedham Internal Medicine

SMG Easton Cardiology

SMG Fall River Family Health

SMG Family Medicine at Carney Hospital

SMG Foxboro Family and Internal Medicine

SMG General Surgery

SMG Great Woods Family Medicine

SMG Groton Internal Medicine

SMG Hanson

SMG Infectious Disease at Morton Hospital

SMG Internal Medicine Health Associates

SMG Lunenburg Family Practice

SMG Methuen Family Medicine

SMG Methuen Pediatrics

SMG Middleboro Internal Medicine

SMG Mill River Internal Medicine

SMG Millview

SMG Morton Internal Medicine

SMG Nashoba Family Medicine

SMG New Boston Village Primary Care

SMG New England Family Practice of Andover

SMG Newton Primary Care

SMG Primary Care and Women's Health Haverhill

SMG Primary Care of Southern New Hampshire

SMG Randolph Internal Medicine

SMG Stanton Internal Medicine

SMG Townsend Family Practice

SMG Walpole OB/GYN

SMG Watertown Primary Care & OB/GTN

SMG West Roxbury Internal Medicine

SMG Women's Health at Nashoba Valley

SMG Women's Health Brighton

SMG Wrentham Internal Medicine

Trinity Family Medicine LLC

Tristan Medical, PC

Tural Pediatrics, PC

UMass Memorial Healthcare, Inc.

Participating Primary Care Clinician sites include:

Auburn Internal Medicine

Barre Family Health Center

Benedict Family Medicine

Benedict Internal Medicine

Berlin Internal Medicine

Bolton Family Medicine

Bolton Street Primary Care

Chadwick Square Internal Medicine

Community Health Link Primary Care

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MassHealth

All-Provider Bulletin 262

November 2016

Page 8

UMass Memorial Healthcare, Inc. (cont.)

Community Women's Care

Dennis M Dimitri, MD, Family Medicine

East Douglas Internal Medicine

Family Doctors

Fitchburg Adult Medicine

Fitchburg Family Medicine

Grafton Internal Medicine

Grove Family Medicine

Grove Street Internal Medicine

Hahnemann Family Health Center

Hahnemann Medical Group

Harvard Primary Care

Health Alliance Fitchburg Family Practice

Holden Family Medicine

Infectious Diseases Memorial Campus

Infectious Diseases University Campus

Leominster Internal Medicine

Lincoln OB/GYN

Lincoln Primary Care

Lincoln Street Internal Medicine

Lincoln Street Pediatrics

Lincoln Street Primary Care

Marlborough Family Doctors

Marlborough Internal Medicine

Marlborough Medical Associates

Marlborough Primary Care

Millbury Internal Medicine

Montachusett Internal Medicine

Nashaway Pediatrics–Clinton

Nashaway Pediatrics–Sterling

Northborough Crossing Primary Care

Northborough Medical

Pediatric Primary Care University Benedict

Plumley Village Health Center

Shrewsbury Family Medicine–

24 Julio Drive

Shrewsbury Family Practice–

604 Main Street

Shrewsbury Internal Medicine–

604 Main Street

Shrewsbury Primary Care

South County Pediatrics

Spencer Adult and Pediatric Primary Care

Sterling Family Medicine

Sutton Internal Medicine

Tri River Family Health Center

West Boylston Family Medicine

Westborough Adult and Pediatric Medicine

Westborough Internal Medicine

Winthrop Street Family Medicine

Worcester Internal Medicine–Geriatrics

Worcester Internal Medicine-CMG

Questions

If you have any questions about the information in this bulletin, please contact the MassHealth Customer Service Center at 1-800-841-2900, e-mail your inquiry to providersupport@, or fax your inquiry to 617-988-8974.

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